Tuesday, January 18, 2011

Clinicians Going for a Swim and Drowning in Information

Clinicians these days at computerized facilities are often drinking information from a firehose, and even worse.

Just to make their tasks more difficult, the firehose is difficult to use, it sputters on occasion due to "glitches" in the water pumps, and sometimes even emits fouled water due to problems at the reservoir or connecting pipes, without frequent "workarounds" and mental gymnastics by the clinicians. I've seen it personally in the care of relatives.

This is far from the dream of Medical Informatics, whose specialists viewed IT as a tool to reduce cognitive overload and make healthcare provision more efficient.

Why is information overload a bad thing?

Here's why:

New York Times
In New Military, Data Overload Can Be Deadly
January 16, 2011

When military investigators looked into an attack by American helicopters last February that left 23 Afghan civilians dead, they found that the operator of a Predator drone had failed to pass along crucial information about the makeup of a gathering crowd of villagers.

But Air Force and Army officials now say there was also an underlying cause for that mistake: information overload.

At an Air Force base in Nevada, the drone operator and his team struggled to work out what was happening in the village, where a convoy was forming. They had to monitor the drone’s video feeds while participating in dozens of instant-message and radio exchanges with intelligence analysts and troops on the ground.

There were solid reports that the group included children, but the team did not adequately focus on them amid the swirl of data — much like a cubicle worker who loses track of an important e-mail under the mounting pile. The team was under intense pressure to protect American forces nearby, and in the end it determined, incorrectly, that the villagers’ convoy posed an imminent threat, resulting in one of the worst losses of civilian lives in the war in Afghanistan.

“Information overload — an accurate description,” said one senior military officer, who was briefed on the inquiry and spoke on the condition of anonymity because the case might yet result in a court martial. The deaths would have been prevented, he said, “if we had just slowed things down and thought deliberately.”

Data is among the most potent weapons of the 21st century. Unprecedented amounts of raw information help the military determine what targets to hit and what to avoid. And drone-based sensors have given rise to a new class of wired warriors who must filter the information sea. But sometimes they are drowning.

Research shows that the kind of intense multitasking required in such situations can make it hard to tell good information from bad. The military faces a balancing act: how to help soldiers exploit masses of data without succumbing to overload.

Read the entire NY Times piece.

I have no other comments to offer, other than (as the military seems to recognize for its own needs through engaging experts in domains such as neuroscience), the time to "accelerate interdisciplinary research in biomedical informatics, computer science, social science, and health care engineering" as recommended in 2009 by the National Research Council is before the attempted national rollout of hundreds of billions of dollars of technology.

The time to do so is not during - and certainly not after - the HITECH-led medical re-engineering attempt.

Finally, unlike the health IT industry, I don't see the military attributing these issues to "Luddite soldiers."

-- SS


Anonymous said...

Doctors, when working feverishly to save the life of a patient afflicted with multi-organ failure, do not have the time to wade through the pages of legible gibberish certified by C$HIT to diagnose the etiologies of the illness. Like wise, doctors taking care of less complex cases do not have the time to find out why a medication that the patient was ordered to get slipped off the e-MAR, especially after the patient has a stroke because of the goof.

Anonymous said...

We have another new issue to deal with concerning EMR’s. It has become common in NE Ohio for private medical practices to be sold to a hospital group.

The Jan. 17, 2011 Akron Beacon Journal highlights one consequence of this action in Pained by hospital fees, Some doctor visits can have extra cost reaching thousands. The article highlights Dr. David Hoff and the bill received for an office visit to have a stent removed due to some kidney stones.

“He didn’t, however, expect a doctor visit that lasted less than 15 minutes to result in a $3, 123 “treatment room” charge from Akron General Medical Center.”

The article then goes on to highlight the increasing use of charges in these now hospital extensions. The claim by the hospital groups is this is to cover certification and additional paper work.

My opinion is that doctors are seeking refuge from the ever growing list of demands by government and insurance companies, one being EMR’s, with the end result of the sale of their practices to an entity whose promise is to remove this burden, but who’s intention is to maximize income through additional fees.

The end result of claims that EMR’s will provide lower cost is false since the insurance companies, as highlighted by the article, are looking at the fees in relation to future premium increases.

On top of the rush to spend billions on this new technology, large amounts will be spent in increased premiums, all in the name of technology.

Steve Lucas